[Traveler]

For many hospitals it is not staffing that is an issue- it is level of service that we are able to provide. Currently I work in home health in a small town 45 minutes from my house. In that town is the closest hospital to my house. It has 25 beds with limited telemetry, no surgical services, no anesthesia. There is a CT but the MRI comes around once a week on a van. In many cases the patients need to get out of there and to a bigger facility. The less urgent ones are transported by ambulance down a twisty mountain road along the river. Until 2 weeks ago, this road had been closed for 3 weeks due to a landslide of 150,000 tons of rock and dirt. Most of the time these folks are flown out. You never know the other side of it until you are there.

[mommynurse4]

Originally Posted by deespoohbear

I don't know if it is just our particular facility or what, but we have had major problems getting the larger facilities to accept pts for transfer. We are a small hospital, and there are certain conditions we are not equipped to handle. But lately when our family docs have tried to get a patient to a larger facility, no physician wants to accept them. I am talking about cases like a 13 y/o with a grand mal seizure (with no history of seizures) who is post-ictal for hours. We do not have a neurologist or a pediatrician on staff at our facility.... took about 14 hours to convince a peds guy to accept this kid....(kid ended up having viral encephalitis)...complicated pneumonia in a young adult failing to respond to antibiotics...the docs at the larger facilities don't want to accept these cases....gets real frustrating at times....anyone else running into this problem?

We receive many transfers from outling areas.However,most times the patient we accept is very different from the one we receive. Many times we can't let the ambulance personnel unload the patient because the patient is half dead when we get them. if we were told about some problems they had they would be taken by helicopter , not ambulanc ,and put in I.C.U.instead of a regular room. We have coded many patients within minutes of receiving
them. There are 2 sides to every situation ,in most cases the transfering facility has not been completly truthful obout the patient status.

[student4ever]

Our ER rarely sends patients in a direct admit status. We are a medium sized semi-rural area hospital. I say semi rural because we are in a mid-sized city, have approx 200 bed inpt capacity, but we serve a HUGE rural area including very rural parts of a neighboring state. We have a lot of VERY small RURAL hospitals who send their patients to our ER for surgical consult because they have no OR. But we are not recognized as a trauma hospital, though we take trauma, stabilize as best as we can, and ship it out. Most times we ship to the teaching hospital an hour away, to their ER. That way they can evaluate and decide on their diagnosis, without having to deal with their specialists in the middle of the night. Their chopper comes and picks the pts up, or if the chopper won't fly due to weather, we ship accross the mountain by private ambulance. We've always had a great relationship with their ER, which is rated among the top 100 (maybe even higher? not sure) ERs in the nation. I disagree with the poster who said be careful about sneaking a pt in an ER to ER transfer. As long as you don't show up with a critical pt unannounced, I think ER to ER transfers are great, and we do it frequently. In our rural area, there are tons of terrible MVCs, ATV accidents, farm accidents, freak accidents, you name it. In two years, I have seen more nasty accidents (and domestic arguments gone haywire) then I ever would have guessed. High risk OB stuff goes over the mountain without a hitch as well.

[mommynurse4]

Originally Posted by student4ever

Our ER rarely sends patients in a direct admit status. We are a medium sized semi-rural area hospital. I say semi rural because we are in a mid-sized city, have approx 200 bed inpt capacity, but we serve a HUGE rural area including very rural parts of a neighboring state. We have a lot of VERY small RURAL hospitals who send their patients to our ER for surgical consult because they have no OR. But we are not recognized as a trauma hospital, though we take trauma, stabilize as best as we can, and ship it out. Most times we ship to the teaching hospital an hour away, to their ER. That way they can evaluate and decide on their diagnosis, without having to deal with their specialists in the middle of the night. Their chopper comes and picks the pts up, or if the chopper won't fly due to weather, we ship accross the mountain by private ambulance. We've always had a great relationship with their ER, which is rated among the top 100 (maybe even higher? not sure) ERs in the nation. I disagree with the poster who said be careful about sneaking a pt in an ER to ER transfer. As long as you don't show up with a critical pt unannounced, I think ER to ER transfers are great, and we do it frequently. In our rural area, there are tons of terrible MVCs, ATV accidents, farm accidents, freak accidents, you name it. In two years, I have seen more nasty accidents (and domestic arguments gone haywire) then I ever would have guessed. High risk OB stuff goes over the mountain without a hitch as well.

The only transfers that go to the ED are traumas. Every one else is a transfer that comes in the front door via ambulance . The sending MD has given report to the receiving MD . The patients are very different from the report. I have no problem taking the patients - we are the largest teaching hospital in our region. We receive patients from 4 states as well as our own- however ' please tell us what we are getting. so we can prepare.

[mim-o]

Well i have been on both ends of this situation-sometimes you don't get the whole picture when you are on the recieving end till they arrive-then it has the potential to be a catastrophe for the patient and us. Had one patient that came to floor via ambulance. Literally 15 minutes after arrival the patient went into DIC and coded -Just got thru orienting them to their room-

On the other end of the spectrum I have had horrible issues with transferring when at a smaller facility not because of Dr.s, but because of transportation-the local rescue squads will give you the run around. Each one you call tells you to call the the other one and so forth. This can go on for an hour or more. Meanwhile where is my patient-still there WITH NO NURSE AT BEDSIDE because I am on the phone trying to arrange transport-ridiculus!!!! There was no unit secratary or even CNA's it was just you. I hated it when that happened.

[ranchwife]

I guess I should thank my lucky stars!!! About the only problem we have here in the madison valley with transfer of pts to a larger facility is transport!! If Life Flight is needed from EIRMC or Billings, then we start praying for cooperative weather so that they may land! If they are travelling by ground, then we start praying that enough of our VOLUNTEER emt's respond to the page out for a simple transfer!!